The COPD-X Plan – Version 2.26 Endorsed by the following organisations according to their respective approved criteria: This document should be cited as: David K McKenzie, Michael Abramson, Alan J Crockett, Nicholas Glasgow, Sue Jenkins, Christine McDonald, Richard Wood-Baker, Peter A Frith on behalf of The Australian Lung Foundation. The COPD-X Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2010 Originally published as: David K McKenzie, Peter A Frith, Jonathan G W Burdon and G Ian Town. The COPDX Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2003. MJA 2003 178(6 Suppl 17 Mar): S1-S40 www.mja.com.au/public/issues/178_06_170303/tho10508_all.html Clinical Practice Update Michael J Abramson, Alan J Crockett, Peter A Frith and Christine F McDonald. COPDX: an update of guidelines for the management of chronic obstructive pulmonary disease with a review of recent evidence. MJA 2006; 184 (7): 342-345 www.mja.com.au/public/issues/184_07_030406/abr10742_fm.html © 2011 The Australian Lung Foundation Page 1 The COPD-X Plan – Version 2.26 Contents Authors ...................................................................................................................................................................................................... 6 Authors and contributors to the original guidelines - 2003 .................................................................................................................. 8 Foreword ................................................................................................................................................................................................... 9 The COPD guidelines ............................................................................................................................................................................. 10 Levels of evidence ................................................................................................................................................................................. 11 Executive Summary of the COPDX guidelines .................................................................................................................................... 12 C: Confirm diagnosis and assess severity .......................................................................................................................................... 15 C1. Aetiology and natural history .......................................................................................................................................................... 16 C2. Diagnosis ....................................................................................................................................................................................... 19 C2.1 History ...................................................................................................................................................................................... 19 C2.2 Physical examination ............................................................................................................................................................... 19 C2.3 Spirometry ............................................................................................................................................................................... 19 C2.4 Flow volume tests .................................................................................................................................................................... 21 C3. Assessing the severity of COPD .................................................................................................................................................... 21 C4. Assessing acute response to bronchodilators ................................................................................................................................ 21 C4.1 Confirm or exclude asthma ...................................................................................................................................................... 22 C5. Specialist referral ........................................................................................................................................................................... 23 C5.1 Complex lung function tests ..................................................................................................................................................... 23 C5.2 Exercise testing ........................................................................................................................................................................ 23 C5.3 Sleep studies ........................................................................................................................................................................... 24 C5.4 Chest x-rays ............................................................................................................................................................................. 24 C5.5 High resolution computed tomography .................................................................................................................................... 24 C5.6 Ventilation and perfusion scans ............................................................................................................................................... 24 C5.7 Transcutaneous oxygen saturation .......................................................................................................................................... 24 C5.8 Arterial blood gas measurement .............................................................................................................................................. 24 C5.9 Sputum examination ................................................................................................................................................................ 24 C5.10 Haematology and biochemistry .............................................................................................................................................. 24 C5.11 Electrocardiography and echocardiography ........................................................................................................................... 25 C5.12 Trials of Therapy .................................................................................................................................................................... 25 O: Optimise function .............................................................................................................................................................................. 26 Confirm Goals of Care .......................................................................................................................................................................... 26 O1. Inhaled bronchodilators ................................................................................................................................................................. 27 O1.1 Short-acting bronchodilators .................................................................................................................................................... 27 O1.1.1 Short-acting beta-agonists ............................................................................................................................................... 27 O1.1.2 Short-acting anticholinergics ............................................................................................................................................ 27 O1.1.3 Short-acting bronchodilator combinations........................................................................................................................ 28 O1.2 Long-acting bronchodilators .................................................................................................................................................... 28 O1.2.1 Long-acting anticholinergics ............................................................................................................................................ 28 O1.2.3 Long-acting beat-agonists ............................................................................................................................................... 29 O1.2.3 Long-acting bronchodilator combinations ........................................................................................................................ 29 O1.3 Assessment of response and continuation of bronchodilator therapy ...................................................................................... 29 © 2011 The Australian Lung Foundation Page 2 The COPD-X Plan – Version 2.26 O2. Oral bronchodilators ...................................................................................................................................................................... 29 O2.1 Methylxanthines ....................................................................................................................................................................... 29 O2.2 Phosphodiesterase type-4 inhibitors ........................................................................................................................................ 30 O3. Glucocorticoids .............................................................................................................................................................................